While some babies seem content to do most of their sucking to obtain nourishment, others just can’t seem to get enough, even being born with a “suckle knuckle” — a blister on the hand from vigorous in-the-womb suckling. Evidence of “pacifiers” to placate babies goes back at least 3,000 years. Historically, there have been concerns about safety (pacifiers have not always had the safety ring preventing choking), hygiene (a discarded rag may have been wrapped around a chunk of meat, bread or a sachet of sugar dipped in wine), morality (thanks in part to Freud, sexualizing the pacifier along with everything else), malocclusion (crooked teeth) and impact on breastfeeding.
So what is the evidence? Babies tend to kick a binky quicker than a thumb, but they both have about the same impact on the structure of the mouth. The idea of “nipple confusion” from pacifier use is a notion from popular opinion, not empiric evidence. A recent review of the best research available found that for healthy term babies, pacifier use had no significant impact on the duration of breastfeeding up to four months following birth. Quality research is lacking to evaluate the impact of pacifier use on the duration of breastfeeding beyond four months.
The most compelling evidence supporting the use of a pacifier is the observed reduction of risk of sudden infant death syndrome. Why is not entirely clear; some theorize it may lower the threshold for arousal during critical events such as arrhythmia, or cessation of breathing. My take on the evidence? If an otherwise healthy, thriving, successfully feeding super-suckler is more content between feedings with a clean, safe binky — two thumbs up!